Endocarditis

Question 1

Non infective causes of endocarditis when negative culture

Answer 1

Rare - usually secondary to hypercoagulable states eg pregnancy, cancers or infection elsewhere
Libman-Sacs
APS, vasculitis, CTD
Uncommon organsism - zoonotic, fungal

Question 2

Infective causes of endocarditis

Answer 2

• Staphylococci aureus
  enterococcus
  Viridans strep
• Streptococci
• Fungal

Question 3

Clinical features of infective endocarditis - groups

Answer 3

New valve pathology (new murumur, abnormal ECHO)
Infection signs - fever, elevated biochem and haem markers
Systemic embolisation

Question 4

Signs of systemic embolisation

Answer 4

Stroke, mycotic aneurysm
Renal/splanchic infarction
Immunologic phenomena
Vasculitis phenomena
Splinter haemorrhages
Roth spots - eyes - immunologic
Petechiae skin
Oslers nodes - red nodules - immunologic
Janeway lesions - purpura - embolic

Heart murmur if LHS

Question 5

What is the criteria for Infective endocarditis

Answer 5

Duke criteria

Question 6

Major DUKE criteria

Answer 6

Blood culture positive for typical organisms
ECHO - valvular vegetation

Question 7

Minor criteria for DUKE

Answer 7

Predisposing cardiac lesion
IVDU
Temp >38 degress
Embolic phenomena
Immunologic phenomena
+blood culture atypical pathogens

Question 8

Definite IE on DUKES

Answer 8

1 major and 3 minor criteria

Question 9

Possible IE on Dukes criteria

Answer 9

1 major and 1 minor
3 minors

Question 10

When is it defiitiely not IE

Answer 10

<4 days resolution with anitbiptcs

Question 11

What investigation diagnoses IE and how done

Answer 11

Blood culture
x3 over 30-60 mins from different sites
Before antibiotics commenced

Question 12

Investigations IE

Answer 12

Blood culture
FBC, U+Es, LFTs, CRP, ESR, , Rf, APS antibodies
TOE - preferred to TTE, 1st line ECHO investigation
CXR - pulmonary septic emboli, signs of HF - effusion etc
CT - metastatic abscesses
ECG - heart block, ichaemia, conduction delay

Question 13

What further investigation do if group D strep/strep bovis causative

Answer 13

Colonsocopy - ass with colon lesions

Question 14

What antibiotics give initially IE

Answer 14

Amoxicillin for native valve +/- gentamicin
Vancomycin if allergic, s.aureus sus, severe sepsis
Vancomycin + meroponem sev sepsis w group neg strep

Prosthetic - Vancomycin + rifampacin + gentamicin

Question 15

How long give antibiotics for

Answer 15

4 weeks natiev valve
6 weeks prosthetic valve

Question 16

Risk factors IE

Answer 16

> 60, male
Prosthetic valve, ICD, structural HD
IVDU
Chronic haemodialysis w fistula or catheter
Intravascular lines
Dental infections/surgical
Immunocompromised

Question 17

Staph infection treatment IE

Answer 17

Native - flucloxacillin
Prosthetic - flucloxacillin + rifampacin + gentamicin

Question 18

Strep cause IE treat

Answer 18

Native or prosthetic -> Benzylpenicillin +/- gentamicin

Question 19

HACEK/enterococci treat IE

Answer 19

Amoxicillin + gentamicin

Question 20

When do early valve surgery IE

Answer 20

Intracardiac abscess
CCF
Valvular dysfunction
Persistent infection